addressing the boomer challenge
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March 15, 2012
The Long-Term Services and
Supports
Addressing the Boomer Challenge
2012 Health Policy Roundtables
Today’s Discussion
• The urgency of long term services and supports—what’s the hurry? • Changing demographics
• A summary of LTSS• Financing LTSS• On the Horizon: Where do we go from here?
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The Challenge and Urgency of LTSS:
Changing Demographics3
What are Long Term Services and Supports?
“A broad range of supportive services needed by people who have limitations in their ability to perform daily activities because of a physical, cognitive, or mental disability or condition.”
SOURCE: O’Shaughnessy, C. (2010). The Basics: National Spending for Long-Term Services and Supports (LTSS). National Health Policy Forum.
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65+ Age Distribution in Colorado
SOURCE: Colorado State Demography Office, population estimates, 2000-20305
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Where do Elders Receive Long-Term Services and Supports?
•Informal services (family/ friends); personal and skilled services; adult day care
At home•Group homes; assisted
living facilities; adult foster care
Residential setting
•Nursing facilities Institutional setting
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• Provides long term services and supports and acute care to individuals dually enrolled in Medicare and Medicaid
• Led by interdisciplinary team that coordinates care
• PACE providers receive a fixed monthly rate from Medicare/Medicaid or Medicare/private pay
• 1,900 PACE Medicaid enrollees in Colorado 9
Program for All Inclusive Care for the Elderly (PACE)
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Financing Long Term Services and
Supports10
Who Pays for Long term Services and Supports?
SOURCE: Komisar, H, and L Thompson. (2006). National Spending for Long-term Care. 11
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Interaction Between Acute and LTSS Insurance for Elders
• The CLASS Act• Voluntary long term care insurance program• Premiums not based on health status
• Feb. 2012 CLASS Act was repealed by US House of Reps.• Adverse selection• Financially insolvent – distributions would
exceed collections
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The Lack of Long Term Care Insurance
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Colorado General Fund Operating Appropriations
SOURCE: Joint Budget Committee, FY 2011-12 Appropriations Report.
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Medicaid Medical Services Premiums, FY 2011-12
SOURCE: Colorado Department of Health Care Policy and Financing, FY 2012-2013 Budget RequestNotes: Projected General Fund expenditures before bottom line financing adjustments.
Medicaid LTSS Expenditures, FY 03-04 to FY 10-11
SOURCE: Colorado Department of Health Care Policy and Financing16
2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11
In M
illio
ns
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Where do we go from here?
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Mechanisms Being Considered to Reform Medicaid System
• Colorado’s Money Follows the Person program• Transitions people from
nursing facilities to the community when desired and feasible
Moving people out of nursing facilities: Colorado Choice Transitions
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• HB 10-1053 (Riesberg/Boyd) • Analysis of tiered rate setting for assisted
living • Potential for increasing assisted living rates
to postpone nursing facility placement• SB 12-128 (Roberts/Summers):• Allows HCPF to provide clients at risk of nursing
facility placement enhanced assisted living services • Moves individuals in nursing facilities to
assisted living20
Changing Reimbursement to Prolong Assisted Living
• Coordination of care for individuals dually enrolled in Medicaid and Medicare (“dual eligibles”) • Possible inclusion of dual eligibles in Colorado Medicaid’s accountable care collaborative (ACC)
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Dual Eligibles Planning Grant: Coordinating Care
• SB 12-127 (Newell/Summers): • Allows LTC providers to contract with
RCCOs in ACC• In response to dual eligibles planning
grant
• SB 12-023 (Boyd)• Require RCCOs to inform enrollees about
PACE, if they are eligible
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Coordination of Long Term and Acute Care
• Redesign care planning tool and assessment form for community based long term care services• In future could create person-centered “budget” for each enrollee • Care plans would lead to less subjective decision making by care managers. • Request included in HCPF’s FY 2012-13 budget proposal
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Person-Centered Payments in Long-Term Care
• The state (HCPF/DHS) currently has multiple HCBS waivers• Upcoming legislation to move all waivers to HCPF• First step in process to consolidate waivers• Problem: Waiver participants can’t get
services outside their designated waiver• Concerns: Individuals do not want to
lose services24
Waiver Consolidation
• Medicaid Managed LTSS• Institution to Community/ Home Focus• Little evidence to support
• What’s needed• Careful design• Expertise• Financial resources
Managed Care Models
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Amy Downs720.382.7091 downsa@coloradohealthinstitute.org
“Boomers are just the beginning." - Rich Umbdenstock, President, American Hospital Association
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